New Changes Coming to ACA Marketplace Individual Insurance

If you have individual health insurance (either from your state marketplace or from

Healthcare.gov), there are many changes coming due to new federal laws. However, there continue to be updates and new rulings, so some of these changes and dates are a moving target. DHC will decipher and report on these for you over the coming weeks and months.

One change we want to tell you now is that the rule for a shorter open enrollment period has been pushed back a year. Therefore, open enrollment this year will start on November 1, 2025, and extend to January 15, 2026, in most states. For people using Healthcare.gov and some state marketplaces, you will still have to pick your plan by December 15th if you want coverage to start on January 1st, otherwise, it will start on February 1st. You can browse or “window shop” new plans starting on October 1st to see what’s available in your area.

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Thinking About Quitting Your Job and Getting Individual Insurance? Not So Fast

If you are considering quitting your job soon to retire early (before you are eligible for Medicare) or to become self-employed, you probably know you can get individual insurance when your job-based insurance ends. But you may want to check the prices first of individual marketplace health plans. The cost of insurance premiums has already been increasing faster than inflation and salaries. But due to several factors such as new federal rules and expiring enhanced subsidies, they are set to increase even more for the coming year, possibly by 30% to 60%. This will make them unaffordable for many people. And insurance premiums also increase the older

someone is, which makes them more expensive if you are near retirement age.

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Tips to Help You Fight Insurance Denials

Have you had your health plan deny a treatment recommended by your doctor? You are not alone, as this is unfortunately common — but there are steps you can take to fight it. These include having your provider help to appeal the decision, keeping track of all your paperwork, asking your Human Resources department for help, finding an advocate if needed, and being persistent. Many but not all denials are overturned when people appeal, and you won’t know if you don’t ask.

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Finding New Health Insurance When You Turn 26

People without job-based health insurance need to find new insurance when they turn 26, if they have been on their parents’ coverage. As a KFF article states: “Amid the challenges of adulthood, one rite of passage is unique to the United States: the need to find your own health insurance by the time you turn 26. That is the age at which the Affordable Care Act declares that young adults generally must get off their family’s plan and figure out their coverage themselves.”

KFF published “A Guide To Finding Insurance at 26‌” that you or your young family members can use to help secure new insurance. This guide mentions details and tips about where to look for insurance and how to decide.

One thing this guide does not mention are catastrophic plans on the individual insurance marketplace. These are high-deductible basic plans designed for people under 30 years old. However, as of this writing, they are not eligible for discounts from subsidies, therefore a bronze or silver plan might be better for some younger people.